Indications:

Temporal arteritis, migraine, temporal headaches.

Materials:

Size 12 needle, 1 ml procaine or lidocaine.

Technique:

Point of insertion: The temporal artery runs from the external ear to the temple where its pulse is visible and palpable.

Indications:

As for the injection to the stellate ganglion (p. 46); allergic diathesis.

Materials:

60–80-mm-long needle, 5 ml procaine or lidocaine.

Technique:

Point of insertion: At the point of intersection of two auxiliary lines, a vertical line downward from the anterior edge of the mastoid process and a horizontal line one fingerbreadth above the angle of the mandible.

Direction of needle: Perpendicular to the skin toward the contralateral mastoid.

Injection depth: Bone contact at a depth of 30–40 mm (anterior surface of lateral process of the second cervical vertebra); slightly withdraw needle, then advance ventrally 10 mm to arrive in front of the lateral process.

CAUTION: Aspirate! If the position of the needle is correct, a Horner’s syndrome will occur.

Indications:

All acute and inflammatory eye disorders, e. g., keratitis, iridocyclitis, glaucoma; and certain types of headache.

Materials:

40-mm-long needle, 2 ml procaine or lidocaine.

Technique:

The patient’s head is firmly supported; the eyes are held open, looking up and medially. With the tip of the forefinger of the free hand gently force the eyeball upward and toward the nose.

Point of insertion: For the right eye at seven o’clock, for the left eye at five o’clock.

Direction of needle: Back under loose bone contact with the lower orbital wall, then up and in.

Injection depth: At a depth of 30 mm and no more than 35 mm, the needle lies close to the ciliary ganglion.

CAUTION: Aspirate before injection!

Indications:

Trigeminal neuralgia, trismus; also worth trying with headaches of uncertain origin; pain due to malignancy in the area supplied by this nerve.

Materials:

0.8-mm-diameter × 60-mm-long needle, 1–2 ml procaine or lidocaine.

Technique:

Point of insertion: The patient sits with the mouth slightly open; the mandibular notch can be palpated ~ 30 mm in front of the tragus, directly below the center of the zygomatic arch.

Direction of needle: Transversely along the base of the skull toward the middle.

Injection depth: At a depth of ~ 40 mm, the needle strikes the pterygoid process. Withdraw the needle slightly, then advance dorsally 5–10 mm; it is now close to the foramen ovale.

CAUTION: Aspirate before injection! The patient’s pain reaction shows that the needle is in the correct position.

Indications:

Hay fever, vasomotor rhinitis, neuralgia of the second branch of the trigeminal nerve, sinusitis; also worth trying in therapy-resistant headaches and for maxillary pain in the absence of pathological dental findings.

Materials:

0.8-mm-diameter × 60-mm-long needle, 1–2 ml procaine or lidocaine.

Technique:

Point of insertion: At the upper edge of the zygomatic arch, midway between the external ear and the orbital rim.

Direction of needle: When the needle is positioned correctly, it will point toward the zygomatic bone on the other side of the skull (forming obtuse angles to front and below).

Injection depth: At a depth of ~ 50–60 mm, the needle reaches the pterygopalatine fossa.

CAUTION: Aspirate!

Indications:

Head: Pre- and post-apoplectic syndromes, cerebral edema, intracranial vascular spasms, post-concussional syndrome, traumatic epilepsy, paresis of the facial nerve, persistent facial edema after erysipelas; certain types of headache and migraine.

Eyes: Glaucoma, ophthalmic herpes zoster, occlusion of the central retinal artery, thrombosis of the central vein, diseases of the choroid, degenerative disorders of the macula, etc.

Ears: Ménière’s disease, chronic otitis media, sudden deafness, otic zoster, inner-ear deafness, tinnitus, frostbite, allergic disorders, etc.

Nose: Vasomotor rhinitis, chronic sinusitis, etc.

Throat and neck: Hyperthyroidism, neuralgia, cervical syndrome, septic tonsillitis, cervical migraine, etc.

Shoulder: Shoulder/arm syndrome, scalene syndrome, arthrosis deformans, capsular arthritis, post-traumatic stiffening of the joints, etc.

Arm: Brachalgia, causalgia, brachial-plexus neuralgia, phantom-limb pains, post-traumatic osteoporosis, epicondylitis, tendinosis, lymphedema following mastectomy, circulatory disturbances, etc.

Lung: Bronchial asthma, pulmonary tuberculosis, pneumonia, pleurisy, herpes zoster, pulmonary embolism, pulmonary edema, etc.

Heart: Angina pectoris, conditions following myocardial infarction, fibrillation, paroxysmal tachycardia.

Materials:

80-mm-long needle, 2–5 ml procaine or lidocaine.

Technique:

(Herget’s method):

The patient lies supine, with a firm pad under the shoulders, so that the head is bent back and the cervical spine hyperextended.

Point of insertion: At the point of transition from the lower to the middle third, on an auxiliary line between mastoid and sternoclavicular joint on the medial edge of the sternomastoid muscle, ~ 20–30 mm laterally from the midline.

Direction of needle: Perpendicular to skin.

Injection depth: At a depth of 60–70 mm, the point of the needle reaches the tuberculum caroticum, C 6; withdraw needle 2 mm and infiltrate.

CAUTION: Aspirate!

If the needle is in the correct position, the patient develops a homolateral Horner’s syndrome with ptosis, myosis, and enophthalmos. Further signs are increased circulation in cheeks, face, and neck; the conjunctiva and sclera become noticeably injected; anhidrosis of face and neck; lacrimation.

Materials:

40-mm-long needle, 4–5 ml procaine or lidocaine.

Technique:

(according to Leriche and Fontaine, as modified by P Dosch): Point of insertion: The head of the seated patient is bent back and turned away from the side of the injection. At the point of transition from the lower to the middle third of the sternomastoid muscle, place two fingertips of the free hand on the outer edge of the sternomastoid to push the vessels out of the way in a medial and the pleura in a caudal direction. The head of the first rib should now be palpable. The entry point is immediately above the cranial fingertip.